Rabbi Immauel Jakobovits and the Loss of the Deathbed

This post will continue our discussion of Rabbi Immanuel Jakobovits and modern medicine from a prior post- here.

From a historian’s perspective Jacobovits was crucial for the dismissal and writing out of Judaism hundreds of years of deathbed rituals and preparations for a good death and easy passage to the afterlife. In the 1960’s the value of preserving human life in the ICU displaced asking about repentance and the angel of death. The biological concerns of preserving of life took precedent over the psychological, spiritual, and metaphysical. Philip Aries, a French historian, spent twenty years investigating the changing attitudes towards death in Western Civilization. In the Middle Ages, the “dying well” ( ars moriendi) came to primacy as one came to terms with their ultimate demise. What was then important was how the dying faced death. In the mid-20th century, advances in medical technology, particularly the development of the respirator, meant that death could now be delayed and occurred in hospital following a ”great war against death.” A death in the ICU is a failure of medicine rather than a good death. Culturally, death is now culturally invisible. The entire process of fighting death shows more belief and focus on medicine than on religious services and the afterlife. There is no culmination of a religious service with the kiss of death.

The social historian Elliot Horowitz describes an Italian controversy from 1556 in which a Jewish man died suddenly without having confessional performed as part of Jewish Last Rites and was thus refused burial. Those on the side of the deceased claimed that the movements of the man’s lips immediately preceding death should have constituted as a confession. Rabbi Tucazinsky’s Gesher Hachaim records that in 1947 Jerusalem they had a person shout confession every day in the hospital so that everyone can affirm a confession before dying.

The Talmud teaches that, “If one falls sick and his life is in danger, he is told: ‘Make confession, for all who are sentenced to death make confession.’” In the Shulchan Aruch’s codification, based on the language in Mesechet Semachot, where it is ruled that the following text should be recited to the terminally ill: “Many have confessed but have not died; and many who have not confessed died. And, many who are walking outside in the marketplace confess. By the merit of your confession, you shall live. And all who confess have a place in the World-to-Come.” The Early Modern works on deathbed procedures, such as those by Rabbi Aharon Brachia Maavar Yabok, were still essentials for the early 20th century despite numerous editions and translations. These works build on Talmudic and Medieval conceptions and create full orders and regulations for the deathbed rituals. (They are also our binding source for the activities of the Chevra Kaddisha’s performance of Tahara on the deceased.) In contrast, Jakobovits states that the “predominantly “this-worldly” character of Judaism is reflected in the relative sparsely of its regulations on the inevitable passage of man from life to death.”

In the Jewish works of dying well, the goal, according to social historian Avriel Bar-Levav, was to preserve self-control, unlike our current ICU deaths. Typically, deathbeds required a confession of the dying before a minyan. However, lacking such control Maavar Yabok (ch 19) states that one who is on his deathbed, the confession is said on his behalf by an appointed messenger who will read the text in the patient’s presence whether he is conscious or not. One gathers a quorum of ten men around the deathbed in order to pray. The moment the soul decides to submit and leave the body is considered the “kiss of death;” this is different from biological death. The prayer said by those standing around the dying person appears in the standard Hamadrikh and begins with verses calling for God’s mercies. It includes the Priestly Benediction and the prayer for God’s angels and protective spirit is called upon. It is important to note, however, that this prayer is said even if the one in one one’s deathbed (goses) is incontinent and cannot hear the prayers. The prayer, according to these authorities, has an effect on the soul and also on those who are reading it. Even Rabbi Yekutiel Greenwald’s 1951 work, Kol Bo Aveilut assumes these practices and even asks questions such as if one has one rabbi for a last rite, do we send him to the bed of the sinner or the rabbi?

In contrast, Jakobovits assumes that only Christian religious literature has devoted much attention to the problem of ascertaining the exact moment of death. In Judaism, however, this problem has little or no purely religious significance, since there are no sacramental rites to be accorded to the dying prior to the soul’s final departure from the body. From the ritual point of view, the only practical distinction in Jewish Law between a live body and a dead body concerns the rules of defilement cuased by the dead body.Whereas originally there would be a process of dying that included the soul, now in Jakobovits’ view we are limited to the body.

In the full deathbed service, in works such as Maavar Yabok, there are important practices to perform for the dying person and for family and friends which signale the transition between realms. Physical death occurs at the end of this ritual process and the ritual serves to help in demarcating the living from the dead. Even after the physical death, the process of the soul leaving the body is to take the full length of the seven day Shiva period. In modern terms, it would mean that even after the clinical signs of death, there is still a transitional process in which the body is still considered spiritually alive for a period of time. Jakobovits does away with this transitional realm and limited the process to the modern clinical realm of the undertaker: “When the patient dies, his body generally passes from the attention of the physician into the care of the undertaker and the religious officials who attend to its interment.”

Jakobovits acknowledges that, “the earliest Rabbinic sources usually speak of death as the “going out of the soul,” they also concede the view that the association between body and soul is not altogether severed until three days after death.” But he trusts in modern medicine’s designation of biological death and considers that doctors are able to ascertain death. This is in distinction to the position of Rabbi Moshe Isserles who “altogether denies our competence ‘nowadays’ to ascertain the exact moment of death.”

Jakobovits leaves us with an acceptance of the modern clinical definition of death. Originally, there was an unknown moment of death described in deathbed rituals as the “Kiss of Death” which signifies was the social moment when we had previously assumed the person had died. Now, that moment is identified entirely with the physical death. Gone are discussions of afterlife or how sickness and death are part of the religious cycle of the community. But equally as important is that we have lost any discussion of the social declaration of death such as how do families and communities note the transition of a member from life to death? The days of death rituals assumed a period between life and death, a process of dying. From the perspective of ordinary cases of end of life , the issues of futility, refusal and withdrawal of care is paramount, while the definition of death is a much rarer concern. Aristotle designates four souls: mineral, plant, animal, and human. Platonists added a fifth: the spiritual. The plant soul is digestion, animal soul is reactive, and human soul is rational or thought processes. Much of the halakhic death debate concerns over the vegetable and animal souls, little is said about the human soul, and much of the traditional process of death is now viewed as a legal moment.

The new approach of medical death in the ICU and the halakhah created for it makes all death a failure of medicine. It turns dying into a moment not a process. The way we deal with the denial of death is to control it through medical definition. Philip Aries showed that there were many stages of dying from becoming sick to maggots on a decaying body, even physical decay was not the end. Once there was the death of the human, the animal and vegetable aspects of human life took until the end of shiva to be completed. The assumption was that the body as organism felt the pain of the grave and the maggots. (For many others, the claim of the dying on his/her body continues until the resurrection of the dead. This position was still held by Rabbi Waldenberg but scoffed as superstition to those with medical models.)

The approach started by Rabbi Jakobovits was continued by almost all halakhic/Orthodox rabbis who deal with medical ethics. Their comments deal almost exclusively with problems of life, rather than with the subject of death. The sociologist Peter Berger notes that death is an essential feature of the human condition that requires people to develop means of coping with it, to neglect death in the ICU death is to ignore one of the few universal parameters in which social and individual life are constructed. The contemporary sociologist Anthony Giddens argues that in our era of `late’ modernity’, there are three changes: the experience of death has become increasingly privatized, there is an increased identification of the self with the body; and the shrinkage of the scope of the sacred. Is there a way to bring back the sacred in an age of hospital death?

As you might remember, this is a failure within Jewish medical ethics I attempt to partialy address in an article that is supposed to appear in the IRF’s (forthcoming?) book on organ donation. Hopefully it will be published at some point.

It may be worth noting that the abolition of traditional death rituals began earlier in England. In 1887 RIJ’s predecessor, Chief Rabbi Nathan Marcus Adler, abolished the practice of the hevra kadisah asking the deceased for forgiveness.

Also, it is unfair to pin so much on RIJ when virtually everything written on death and mourning in English for popular audiences, at least from Maurice Lamm’s 1969 book onward, ignores the soul and recasts all the mourning rituals in modern psychological terms.

AS- These posts are a crowd sourcing submission to the same volume.
Where is the source that Rabbi Adler abolished the practice? Did he give a reason?

In the US, we have Greenwald and Hamadrich still having the practice in the 1950’s and then gone in 69 in Lamm.
Anyone know any other relevant sources? Anyone have pre-1965 Reform and Conservative guides to death handy?

The only source I came across was the EJ entry on burial which provides no explanation. Beyond that I didn’t look into it. I can only speculate that it was abolished because there is something strange to the modern sensibility in publicly addressing a dead person in the second person.

In the US I’ve never been at a funeral where a representative of the hevra kadisha did so in public and my impression is that it is done privately after the tahara. But this may be because the hevra kadisha finishes its job long before burial when it transfers the body to the funeral home or cemetery. In Israel I’ve seen a member of the HK make the announcement publicly after the burial as something like: “ploni b. ploni, we have conducted ourselves according the customs of the HK of Jerusalem, we ask mehila if we slighted you or treated you improperly.”

The current Reform Rabbi handbook has the following vidui- it does seem to be stressed in their literature and the Jewish Lights volumes.

Reform Rabbis’ handbook:

My God and God of all who have gone before me, Author of life and death, I turn to You in trust. Although I pray for life and health, I know that I am mortal. If my life must soon come to and end, let me die, I pray, at peace. If only my hands were clean and my heart pure! I confess that I have committed sins and left much undone, yet I know also the good that I did or tried to do. May my acts of goodness give meaning to my life, and may my errors be forgiven. Protector of bereaved and the helpless, watch over my loved ones. Into Your hand I commit my spirit; redeem it, O God of mercy and truth.

The sacred IS being brought back to death. It is slow, but we are making progress.

The beginning of the revolution can be traced to the 1970’s and the confluence of the Federal Trade Commission and Jessica Mitford challenging and de-mystifying the post-civil war American funeral process. Rabbi Arnold Goodman’s Chevra Kevod Hamet and a smattering of other synagogues began the process of taking back the mitzvot of caring for the body and soul at the end of life. Centered on community, volunteers doing tahara, but also including shmira, sometimes making tachrichim and aronim, and sometimes establishing alternatives to the traditional Jewish funeral home, we are working to bring back an elevated spiritual component beginning with the post-death experience.

In 2000 the creation of the Kavod v’Nichum and in 2010 the start of Chevra Kadisha leadership training in the Gamliel Institute enhanced the Chevra Kadisha movement by providing extensive resources and educational opportunities to take Chevra Kadisha work beyond on-the-job training to an area rich with text study, writings, discussion and research. Expanding in both directions of the death time-line, Chevra Kadisha work is reconstructing the original Prague Chevra Kadisha model and is incorporating bikkur cholim, legacy work, remembrance and viddui at the end of life, while at the same time building on tahara and shmira to include enhancing shiva services to embrace storytelling and providing meals for the family modeled on sheva brachot.

One way to measure a movement is by its scope and vitality. Chevra Kadisha work draws participants because it often leads to strong spiritual experiences. A disproportionately high number of converts and non-heterosexuals are involved in Chevra Kadisha. A new extensive liturgical analysis of the Tahara liturgy attracted 130 participants in a recent webinar. Recent conferences have fully engaged in exploring issues around transgender and tahara. Burial vs. cremation is an active discussion topic. There is a move to develop a ritual washing liturgy for non-Jewish spouses.

By fully immersing ourselves in the hope that a grass roots effort can make significant change, the Chevra Kadisha movement is bringing the sacred back to death.

David Zinner, Executive Director
Kavod v’Nichum and the Gamliel Institute
8112 Sea Water Path
Columbia, MD 21045
410-733-3700info@jewish-funerals.orghttp://www.Jewish-funerals.org
The 11th North American Chevra Kadisha and Jewish Cemetery Conference will be in Center City Philadelphia June 9-11, 2013

I am curious what your sense is of what is “done” in the non-“modern” orthodox world. From my limited experience I think there is more preservation of things like saying shema, etc, w a dying person , even an unconscious one (have not heard viduy but maybe that too), and not leaving them alone. But there is also the same attitude of death as a medical failure, everything up to the moment being about its prevention, etc.
the HK asked mehila of my father in Israel in the way AS describes.

Is this re-framing of death not a legitimate response to technological change ? The focus on moment of death and ICU death reflect the technological reality, not present to anything like the same extent pre 1940, that medicine can often prevent or delay death. It makes sense to view death as 5 day process if you can do nothing to stop its progress. Moment of death is much more relevant when you need to identify when technology has in fact lost the fight. Surely Judaism’s focus on the importance of life, a dominant historical thread, makes Jacobovits and Lamms refocusing in the light of technological change a sensible move ?

The question isn’t whether it’s legitimate, it’s what gets lost sight of. In any event, the technological reality is that death has become a longer, not shorter, process so focusing on the moment fails to deal with that reality as well.

I agree the argument is mostly about what is lost, but the discussion so far was rather unrooted as it ignored this significant contextual factor.
You could argue death being longer/shorter either way – slow progress of chronic debilitating diseases and extension of life by intervention – is this the process of death or process of intervention?, but that is not directly relevant to point made, i.e. technological change explaining the development of moment of death as a concept.